Classifications

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Definitions

• the present disclosure relates generally to diagnostic imaging and, in some non limiting embodiments or aspects, to predicting, anticipating, and/or assessing later phases of medical images and/or tissue characteristics from selected phases.
• Magnetic resonance imaging is an imaging method which is used especially in medical diagnostics for depicting structure and function of the tissue and organs in the human or animal body.
• MRI Magnetic resonance Imaging
• the magnetic moments of protons in an examination object are aligned in a basic magnetic field, with the result that there is a macroscopic magnetization along a longitudinal direction.
• This is subsequently deflected from the resting position by the incident radiation of high-frequency (HF) pulses (excitation).
• HF high-frequency
• the return of the excited states into the resting position (relaxation) or the magnetization dynamics is subsequently detected by means of one or more HF receiver coils as relaxation signals.
• the captured relaxation signals or the detected and spatially resolved MRI data are initially present as raw data in a spatial frequency space, and can be transformed by subsequent Fourier transformation into the real space (image space).
• the tissue contrasts are generated by the different relaxation times (T1 and T2) and the proton density.
• T1 relaxation describes the transition of the longitudinal magnetization into its equilibrium state, T1 being that time that is required to reach 63.21% of the equilibrium magnetization prior to the resonance excitation. It is also called longitudinal relaxation time or spin-lattice relaxation time.
• T2 relaxation describes the transition of the transversal magnetization into its equilibrium state.
• MRI contrast agents develop their action by altering the relaxation times of the structures which take up contrast agents.
• Superparamagnetic contrast agents lead to a predominant shortening of T2, whereas paramagnetic contrast agents mainly lead to a shortening of Tl.
• a shortening of the T1 time leads to an increase in the signal intensity in Tl-weighted MRI images, and a shortening of the T2 time leads to a decrease in the signal intensity in T2 -weighted MRI images.
• contrast agents are indirect, since the contrast agent itself does not give off a signal, but instead only influences the signal intensity of the hydrogen protons in its surroundings.
• Extracellular, intracellular and intravascular contrast agents can be distinguished according to their pattern of spreading in the tissue.
• An example of a superparamagnetic contrast agent are iron oxide nanoparticles (SPIO : superparamagnetic iron oxide) .
• SPIO superparamagnetic iron oxide
• Superparamagnetic contrast agents are commonly used as intravascular agents.
• Examples of paramagnetic contrast agents are gadolinium chelates such as gadopentetate dimeglumine (trade name: Magnevist ® and others), gadobenate dimeglumine (trade name: Multihance ® ), gadoteric acid (Dotarem ® , Dotagita ® , Cyclolux ® ), gadodiamide (Omniscan ® ), gadoteridol (ProHance ® ) and gadobutrol (Gadovist ® ).
• gadolinium chelates such as gadopentetate dimeglumine (trade name: Magnevist ® and others), gadobenate dimeglumine (trade name: Multihance ® ), gadoteric acid (Dotarem ® , Dotagita ® , Cyclolux ® ), gadodiamide (Omniscan ® ), gadoteridol (ProHance ® ) and ga
• Extracellular, intracellular and intravascular contrast agents can be distinguished according to their pattern of spreading in the tissue.
• contrast agents absorb the X-ray radiation created by the CT machine as the X-ray radiation passes through the patient.
• the contrast agent includes radioactive atoms which decay to produce a signal which is detected by the imaging equipment.
• hyperpolarized MRI the majority of nuclei are aligned with a magnetic field and injected into the patient for imaging.
• Contrast agents based on gadoxetic acid are characterized by specific uptake by liver cells, the hepatocytes, by enrichment in the functional tissue (parenchyma) and by enhancement of the contrasts in healthy liver tissue.
• the cells of cysts, metastases and most liver-cell carcinomas no longer function like normal liver cells, do not take up the contrast agent or hardly take it up, are not depicted with enhancement, and are identifiable and localizable as a result.
• Examples of contrast agents based on gadoxetic acid are described in US 6,039,931A; they are commercially available under the trade names Primovist ® or Eovist ® for example.
• the contrast-enhancing effect of Primovist ® /Eovist ® is mediated by the stable gadolinium complex Gd-EOB-DTPA (gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid).
• Gd-EOB-DTPA gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid
• DTPA forms, with the paramagnetic gadolinium ion, a complex which has an extremely high thermodynamic stability.
• the ethoxybenzyl radical (EOB) is the mediator of the hepatobiliary uptake of the contrast agent.
• Primovist ® can be used for the detection of tumours in the liver. Blood supply to the healthy liver tissue is primarily achieved via the portal vein ( vena portae), whereas the liver artery ( arteria hepatica) supplies most primary tumours. After intravenous injection of a bolus of contrast agent, it is accordingly possible to observe a time delay between the signal rise of the healthy liver parenchyma and of the tumour. Besides malignant tumours, what are frequently found in the liver are benign lesions such as cysts, haemangiomas and focal nodular hyperplasias (FNH) . A proper planning of therapy requires that these be differentiated from the malignant tumours.
• FNH focal nodular hyperplasias
• Primovist ® can be used for the identification of benign and malignant focal liver lesions. By means of Tl-weighted MRI, it provides information about the character of said lesions. Differentiation is achieved by making use of the different blood supply to liver and tumour and of the temporal profile of contrast enhancement.
• the contrast enhancement achieved by means of Primovist ® can be divided into at least two phases: into a dynamic phase (comprising the so-called arterial phase, portal -vein phase and late phase) and the hepatobiliary phase, in which a significant uptake of Primovist ® into the hepatocytes has already taken place.
• Non-limiting embodiments or aspects of the present disclosure are directed to improvement of diagnostic imaging examinations, for example in the acceleration or the shortening of scan time (e.g., for the detection and differential diagnosis of focal liver lesions by means of dynamic contrast-enhancing magnetic resonance imaging (MRI), etc.).
• Non- limiting embodiments or aspects of the present disclosure provide methods, systems, and computer program products for predicting, anticipating, and/or assessing later phases of medical images from selected (e.g., earlier, etc.) phases, for example of the liver during the hepatobiliary phase, thereby reducing an image data acquisition time.
• parameters may be determined using data from an imaging sequence which may replace and/or be used to synthesize later images, for example pharmacokinetic parameters of a volume of tissue (e.g., of a voxel, etc.).
• non- limiting embodiments or aspects of the present disclosure are not limited thereto, and methods, systems, and computer program products according to non-limiting embodiments or aspects may predict, anticipate, and/or assess later phases of medical images from selected (e.g., earlier, etc.) phases of medical images of any organ acquired using any imaging modality with or without contrast agent.
• a method comprising the steps of receiving a plurality of MRI images, the MRI images showing an examination region during a first time span, feeding the plurality of MRI images to a prediction model, the prediction model having been trained by means of supervised learning to predict, on the basis of MRI images showing an examination region during a first time span, one or more MRI images showing the examination region during a second time span, generating one or more predicted MRI images showing the examination region during a second time span by means of the prediction, and displaying and/or outputting the one or more predicted MRI images and/or storing the one or more predicted MRI images in a data storage medium.
• a system comprising a receiving unit, a control and calculation unit, and an output unit, the control and calculation unit being configured to prompt the receiving unit to receive a plurality of MRI images, the received MRI images showing an examination region during a first time span, the control and calculation unit being configured to predict one or more MRI images on the basis of the received MRI images, the one or more predicted MRI images showing the examination region during a second time span, the control and calculation unit being configured to prompt the output unit to display the one or more predicted MRI images, to output them or to store them in a data storage medium.
• a computer program product comprising a computer program which can be loaded into a memory of a computer, where it prompts the computer to execute the following steps: receiving a plurality of MRI images, the MRI images showing an examination region during a first time span, feeding the received MRI images to a prediction model, the prediction model having been trained by means of supervised learning to predict, on the basis of MRI images showing an examination region during a first time span, one or more MRI images showing the examination region during a second time span, receiving one or more predicted MRI images showing the examination region during a second time span, as output from the prediction model, displaying and/or outputting the one or more predicted MRI images and/or storing the one or more predicted MRI images in a data storage medium.
• a contrast agent in an MRI method comprising the following steps: administering the contrast agent, the contrast agent spreading in an examination region, generating a plurality of MRI images of the examination region during a first time span, feeding the generated MRI images to a prediction model, the prediction model having been trained by means of supervised learning to predict, on the basis of MRI images showing an examination region during a first time span, one or more MRI images showing the examination region during a second time span, receiving one or more predicted MRI images showing the examination region during a second time span, as output from the prediction model, and displaying and/or outputting the one or more predicted MRI images and/or storing the one or more predicted MRI images in a data storage medium.
• a contrast agent for use in an MRI method comprising the following steps: administering a contrast agent, the contrast agent spreading in an examination region, generating a plurality of MRI images of the examination region during a first time span, feeding the generated MRI images to a prediction model, the prediction model having been trained by means of supervised learning to predict, on the basis of MRI images showing an examination region during a first time span, one or more MRI images showing the examination region during a second time span, receiving one or more predicted MRI images showing the examination region during a second time span, as output from the prediction model, displaying and/or outputting the one or more predicted MRI images and/or storing the one or more predicted MRI images in a data storage medium.
• kits comprising a contrast agent and a computer program product according to non-limiting embodiments or aspects of the present disclosure.
• Non-limiting embodiments or aspects of the present disclosure are more particularly elucidated below without distinguishing between the subjects of embodiments (method, system, computer program product, use, contrast agent for use, kit). On the contrary, the following elucidations are intended to apply analogously to all the subjects of all embodiments, irrespective of in which context (method, system, computer program product, use, contrast agent for use, kit) they occur.
• Non-limiting embodiments or aspects of the present disclosure shorten the time span of the examination of an examination object in the generation of MRI images. In some non- limiting embodiments or aspects, this is achieved by MRI images of an examination region of the examination object being measured in a first time span (magnetic resonance measurement), and the measured MRI images then being used to predict, with the aid of a self-learning algorithm, one or more MRI images showing the examination region in a second time span. The actual magnetic resonance measurement on the examination object is thus restricted to the first time span and does not encompass the second time span.
• the MRI images showing the examination region during the first time span contain information allowing a prediction for the second time span.
• the “examination object” may usually be a living being, preferably a mammal, very particularly preferably a human.
• the examination region may be a portion of the examination object, for example an organ or a portion of an organ.
• the examination region is the liver or a portion of the liver of a mammal (e.g., a human).
• the “examination region”, also called image volume (field of view, FOV), may be in particular a volume which is imaged in the magnetic resonance images.
• FOV field of view
• a 3- dimensional field of view may be said to consist of one or more volume elements or voxels. If a 2-dimensional FOV is being considered, it may be said to consist of 1 or more voxels or 1 or more pixels (picture elements.)
• the examination region may be typically defined by a radiologist, for example on an overview image (localizer). It is self-evident that the examination region can, alternatively or additionally, also be defined automatically, for example on the basis of a selected protocol.
• the examination region is introduced into a basic magnetic field.
• the examination region is subjected to an MRI method and this generates a plurality of MRI images showing the examination region during a first time span.
• plurality means that at least two MRI images or measurements, preferably at least three, very particularly preferably at least four MRI images or measurements are generated.
• a contrast agent which spreads in the examination region is administered to the examination object.
• the contrast agent is preferably administered intravenously as a bolus, in a weight-adapted manner.
• a “contrast agent” is understood to mean a substance or substance mixture, the presence of which in a magnetic resonance measurement leads to an altered signal.
• the contrast agent leads to a shortening of the T1 relaxation time and/or of the T2 relaxation time.
• the contrast agent is a hepatobiliary contrast agent such as, for example, Gd-EOB-DTPA or Gd-BOPTA.
• the contrast agent is a substance or a substance mixture with gadoxetic acid or a gadoxetic acid salt as contrast-enhancing active substance.
• gadoxetic acid a substance mixture with gadoxetic acid or a gadoxetic acid salt as contrast-enhancing active substance.
• disodium salt of gadoxetic acid Gd-EOB- DTPA disodium.
• the first time span starts before the administration of the contrast agent or with the administration of the contrast agent. It is advantageous when one or more MRI images showing the examination region without contrast agent are generated, since a radiologist can already gain important information about the state of health of the examination object in such images. For example, a radiologist can identify bleedings in such native MRI images.
• the first time span preferably encompasses the contrast agent distributing in the examination region.
• the first time span encompasses the arterial phase and/or the portal-vein phase and/or the late phase in the dynamic contrast-enhancing magnetic resonance tomography of a liver or a portion of a liver of an examination object.
• the stated phases are, for example, defined and described in the following publications: J. Magn. Reson. Imaging, 2012, 35(3): 492-511, doi: 10.1002/jmri.22833; harmonyul Medical, 2015, Vol. 88 no. 4: 438-448, DOI: 10.15386/cjmed-414; Journal of Hepatology, 2019, Vol. 71: 534-542, http ://dx.doi .org/ 10.1016/j .jhep .2019.05.005) .
• the first time span is chosen such that such MRI images of the liver or a portion of the liver of an examination object are generated
• the first time span starts within a time span of from one minute to one second before the administration of the contrast agent, or with the administration of the contrast agent, and lasts for a time span of from 2 minutes to 15 minutes, preferably 2 minutes to 13 minutes, yet more preferably 3 minutes to 10 minutes, from the administration of the contrast agent.
• the broad time span can extend up to two hours or more after the administration of the contrast agent.
• the first time span can also be defined via the concentrations of the contrast agent in the different areas of the examination region.
• concentrations of the contrast agent in the different areas of the examination region One possibility is depicted in FIG. 1.
• FIG. 1 shows schematically the temporal profile of the concentrations of contrast agent in the liver arteries (A), the liver veins (V) and the healthy liver cells (P).
• the concentrations are depicted in the form of the signal intensities I in the stated areas (liver arteries, liver veins, liver cells) in the magnetic resonance measurement as a function of the time t.
• the concentration of the contrast agent rises in the liver arteries (A) first of all (dashed curve).
• the concentration passes through a maximum and then drops.
• the concentration in the liver veins (V) rises more slowly than in the liver arteries and reaches its maximum later (dotted curve).
• the concentration of the contrast agent in the healthy liver cells (P) rises slowly (continuous curve) and reaches its maximum only at a very much later time point (not depicted in FIG. 1).
• a few characteristic time points can be defined: At time point TP0, contrast agent is administered intravenously as a bolus. At time point TP1, the concentration (the signal intensity) of the contrast agent in the liver arteries reaches its maximum. At time point TP2, the curves of the signal intensities for the liver arteries and the liver veins intersect. At time point TP3, the concentration (the signal intensity) of the contrast agent in the liver veins passes through its maximum. At time point TP4, the curves of the signal intensities for the liver arteries and the liver cells intersect. At time point T5, the concentrations in the liver arteries and the liver veins have dropped to a level at which they no longer cause a measurable contrast enhancement.
• the first time span encompasses at least the time points TPO, TP1, TP2, TP3 and TP4.
• At least MRI images of all the following phases are generated (by measurement): in the time span from TPO to TP1, in the time span from TP1 to TP2, in the time span from TP2 to TP3 and in the time span TP3 to TP4.
• sequence means a chronological order, i.e. what are generated are multiple MRI images showing the examination region at successive time points.
• a time point is assigned to each MRI image or a time point can be assigned to each MRI image.
• this time point is the time point at which the MRI image has been generated (absolute time).
• a person skilled in the art is aware that the generation of an MRI image uses a certain time span. What can be assigned to an MRI image is, for example, the time point of the start of acquisition or the time point of the completion of acquisition. However, it is also conceivable that arbitrary time points are assigned to the MRI images (e.g. relative time points).
• an MRI image On the basis of a time point, an MRI image can be arranged chronologically with respect to another MRI image; on the basis of the time point of an MRI image, it is possible to establish whether the moment shown in the MRI image took place chronologically before or chronologically after a moment shown in another MRI image.
• the MRI images are chronologically ordered in a sequence and a plurality such that MRI images showing an earlier state of the examination region are arranged in the sequence and the plurality before those MRI images showing a later state of the examination region.
• the time span between two MRI images immediately following one another in a sequence and/or plurality is preferably identical for all pairs of MRI images immediately following one another in the sequence and/or plurality, i.e. the MRI images were preferably generated with a constant acquisition rate.
• one MRI image is predicted or multiple MRI images are predicted which show the examination region during a second time span.
• the second time span follows the first time span.
• the second time span is preferably a time span within the hepatobiliary phase; preferably a time span which starts at least 10 minutes after administration of the contrast agent, preferably at least 20 minutes after administration of the contrast agent.
• the plurality of measured MRI images showing the examination region during the first time span is fed to a prediction model.
• the prediction model is a model configured to predict, on the basis of a plurality of MRI images showing an examination region during a first time span, one or more MRI images showing the examination region during a second time span.
• prediction means that the MRI images showing the examination region during the second time span are calculated using the MRI images showing the examination region during the first time span.
• the prediction model was preferably created with the aid of a self-learning algorithm in a supervised machine learning process. Learning is achieved by using training data comprising a multiplicity of MRI images of the first and the second time span.
• the self-learning algorithm generates, during machine learning, a statistical model which is based on the training data. This means that the examples are not simply leamt by heart, but that the algorithm “recognizes” patterns and regularities in the training data.
• the prediction model can thus also assess unknown data. Validation data can be used to test the quality of the assessment of unknown data.
• the prediction model is trained by means of supervised learning, i.e. pluralities of MRI images from the first time span are presented successively to the algorithm and it is informed of which MRI images in the second time span are associated with these pluralities.
• the algorithm then leams a relationship between the pluralities of MRI images of the first time span and the MRI images of the second time span in order to predict one or more MRI images in the second time span for unknown pluralities of MRI images of the first time span.
• the prediction model is an artificial neural network.
• Such an artificial neural network comprises at least three layers of processing elements: a first layer with input neurons (nodes), an N-th layer with at least one output neuron (nodes) and N-2 inner layers, where N is a natural number and greater than 2.
• the input neurons serve to receive digital MRI images as input values. Normally, there is one input neuron for each pixel or voxel of a digital MRI image. There can be additional input neurons for additional input values (e.g. information about the examination region, about the examination object and/or about conditions which prevailed when generating the MRI images).
• the output neurons serve to predict one or more MRI images of a second time span for a plurality of MRI images of a first time span.
• the processing elements of the layers between the input neurons and the output neurons are connected to one another in a predetermined pattern with predetermined connection weights.
• the artificial neural network is a so-called convolutional neural network (CNN for short).
• CNN convolutional neural network
• a convolutional neural network is capable of processing input data in the form of a matrix. This makes it possible to use digital MRI images depicted as a matrix (e.g. width x height x colour channels) as input data.
• a normal neural network for example in the form of a multilayer perceptron (MLP)
• MLP multilayer perceptron
• MRI image the pixels or voxels of the MRI image would have to be rolled out successively in a long chain.
• normal neural networks are, for example, not capable of recognizing objects in an MRI image independently of the position of the object in the MRI image. The same object at a different position in the MRI image would have a completely different input vector.
• a CNN consists essentially of filters (convolutional layer) and aggregation layers (pooling layer) which are repeated alternately and, at the end, of one layer or multiple layers of “normal” completely connected neurons (dense/fully connected layer).
• Recurrent neural networks are a family of so-called feedforward neural networks which contain feedback connections between layers.
• RNNs allow the modelling of sequential data by common utilization of parameter data via different parts of the neural network.
• the architecture for an RNN contains cycles. The cycles represent the influence of a current value of a variable on its own value at a future time point, since at least a portion of the output data from the RNN is used as feedback for processing subsequent inputs in a sequence.
• the training of the neural network can, for example, be carried out by means of a backpropagation method.
• a backpropagation method In this connection, what is striven for, for the network, is a mapping of given input vectors onto given output vectors that is as reliable as possible. The mapping quality is described by an error function. The goal is to minimize the error function.
• an artificial neural network is taught by altering the connection weights.
• connection weights between the processing elements contain information regarding the relationship between the pluralities of MRI images of the first time span and the MRI images of the second time span that can be used in order to predict one or more MRI images showing an examination region during the second time span for new pluralities of MRI images showing the examination region during the first time span.
• a cross-validation method can be used in order to divide the data into training and validation data sets.
• the training data set is used in the backpropagation training of network weights.
• the validation data set is used in order to check the accuracy of prediction with which the trained network can be applied to unknown pluralities of MRI images.
• Examples of information about the examination object are: sex, age, weight, height, anamnesis, nature and duration and amount of medicaments already ingested, blood pressure, central venous pressure, breathing rate, serum albumin, total bilirubin, blood sugar, iron content, breathing capacity and the like. These can, for example, also be gathered from a database or an electronic patient fde.
• Examples of information about the examination region are: pre-existing conditions, operations, partial resection, liver transplantation, iron liver, fatty liver and the like.
• the plurality of MRI images showing the examination region during the first time span are subjected to a movement correction before they are fed to the prediction model.
• a movement correction ensures that a pixel or voxel of a first MRI image shows the same examination region as the corresponding pixel or voxel of a second, temporally downstream MRI image.
• Movement correction methods are described in , for example: EP3118644, EP3322997, US20080317315, US20170269182, US20140062481, EP2626718.
• a system according to non-limiting embodiments or aspects may execute a method according to non-limiting embodiments or aspects.
• the system comprises a receiving unit, a control and calculation unit and an output unit.
• the stated units are components of a single computer system; however, it is also conceivable that the stated units are components of multiple separate computer systems which are connected to one another via a network in order to transmit data and/or control signals from one unit to another unit.
• a “computer system” is a system for electronic data processing that processes data by means of programmable calculation rules. Such a system usually comprises a “computer”, that unit which comprises a processor for carrying out logical operations, and also peripherals.
• peripherals refer to all devices which are connected to the computer and serve for the control of the computer and/or as input and output devices. Examples thereof are monitor (screen), printer, scanner, mouse, keyboard, drives, camera, microphone, loudspeaker, etc. Internal ports and expansion cards are, too, considered to be peripherals in computer technology.
• Inputs into the computer system are achieved via input means such as, for example, a keyboard, a mouse, a microphone and/or the like.
• the system may be configured to receive pluralities of MRI images showing an examination region during a first time span and to generate (to predict, to calculate), on the basis of these data and optionally further data, one or more MRI images showing the examination region during a second time span.
• the control and calculation unit serves for the control of the receiving unit, the coordination of the data and signal flows between various units, and the calculation of MRI images. It is conceivable that multiple control and calculation units are present.
• the receiving unit serves for the receiving of pluralities of MRI images.
• the pluralities can, for example, be transmitted from a magnetic resonance system or be read from a data storage medium.
• the magnetic resonance system can be a component of the system. However, it is also conceivable that the system is a component of a magnetic resonance system.
• the sequences of MRI images and optionally further data are transmitted from the receiving unit to the control and calculation unit.
• the control and calculation unit is configured to predict, on the basis of the pluralities of MRI images showing an examination region during a first time span, one or more MRI images, the predicted MRI images showing the examination region during a second time span.
• a prediction model which is used to calculate the MRI images of the second time span.
• the prediction model was preferably generated (trained) with the aid of a self-learning algorithm by means of supervised learning.
• the predicted MRI images can be displayed (e.g. on a screen), be outputted (e.g. via a printer) or be stored in a data storage medium.
• a computer-implemented method comprising: obtaining measurement information associated with a parameter of a voxel of tissue of a patient measured at two or more time points, wherein the two or more time points occur before one or more characteristics of the voxel of the tissue are separable in an image generated based on the parameter of the voxel measured at a single time point of the two or more time points; and determining, based on the parameter of the voxel at the two or more time points, the one or more characteristics of the voxel of tissue.
• Clause 2 The computer-implemented method of clause 1, wherein the one or more characteristics of the voxel of tissue are further determined based on information associated with at least one of the patient and a condition of the patient.
• Clause 3 The computer-implemented method of any of clauses 1 and 2, wherein the one or more characteristics of the voxel of the tissue are determined for a time point corresponding to at least one the two or more time points.
• Clause 4 The computer-implemented method of any of clauses 1-3, wherein the one or more characteristics of the voxel of tissue are determined for a time point subsequent to the two or more time points.
• Clause 5 The computer-implemented method of any of clauses 1-4, further comprising: generating, based on the one or more characteristics, one or more images including the one or more characteristics of the voxel of tissue at the time point after the two or more time points.
• Clause 6 The computer-implemented method of any of clauses 1-5, further comprising: determining that the measurement information associated with the parameter of the voxel of the tissue of the patient includes a threshold amount of measurement information associated with determining the one or more characteristics of the voxel of the tissue; and in response to determining that the measurement information includes the threshold amount of measurement information, controlling an imaging system to automatically stop acquisition of the measurement information.
• Clause 7 The computer-implemented method of any of clauses 1-6, wherein determining the one or more characteristics includes: feeding the measurement information associated with the parameter of the voxel of the tissue of the patient to a prediction model, the prediction model having been trained by means of supervised learning to predict, on the basis the measurement information associated with the parameter at the two or more time points, the one or more characteristics of the voxel of the tissue.
• determining the one or more characteristics includes: fitting a pharmacokinetic/pharmacodynamic (PK/PD) model of the voxel of the tissue to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the PK/PD model fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• PK/PD pharmacokinetic/pharmacodynamic
• determining the one or more characteristics includes: fitting a PK PD curve of a plurality of plurality of PK PD curves precomputed for the parameter to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the PK PD curve fitted to the parameter at the two or more time points, the one or more characteristics of the voxel of the tissue.
• determining the one or more characteristics includes: approximating a curve representing the one or more characteristics of the voxel of the tissue with a set of basis functions; fitting the approximated curve to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the approximated curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• determining the one or more characteristics includes: fitting a curve of a plurality of curves precomputed for the parameter with a set of basis functions to the parameter of the voxel of the tissue measured at the two or more time points; determining, based on the curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• a system comprising: one or more processors programmed and/or configured to: obtain measurement information associated with a parameter of a voxel of tissue of a patient measured at two or more time points, wherein the two or more time points occur before one or more characteristics of the voxel of the tissue are separable in an image generated based on the parameter of the voxel measured at a single time point of the two or more time points; and determine, based on the parameter of the voxel at the two or more time points, the one or more characteristics of the voxel of tissue.
• Clause 13 The system of clause 12, wherein the one or more characteristics of the voxel of tissue are further determined based on information associated with at least one of the patient and a condition of the patient.
• Clause 14 The system of any of clauses 12 and 13, wherein the one or more characteristics of the voxel of the tissue are determined for a time point corresponding to at least one the two or more time points.
• Clause 15 The system of any of clauses 12-14, wherein the one or more characteristics of the voxel of tissue are determined for a time point subsequent to the two or more time points.
• Clause 16 The system of any of clauses 12-15, wherein the one or more processors are further programmed and/or configured to: generate, based on the one or more characteristics, one or more images including the one or more characteristics of the voxel of tissue at the time point after the two or more time points.
• Clause 17 The system of any of clauses 12-16, wherein the one or more processors are further programmed and/or configured to: determine that the measurement information associated with the parameter of the voxel of the tissue of the patient includes a threshold amount of measurement information associated with determining the one or more characteristics of the voxel of the tissue; and in response to determining that the measurement information includes the threshold amount of measurement information, control an imaging system to automatically stop acquisition of the measurement information.
• Clause 18 The system of any of clauses 12-17, wherein the one or more processors are further programmed and/or configured to determine the one or more characteristics by: feeding the measurement information associated with the parameter of the voxel of the tissue of the patient to a prediction model, the prediction model having been trained by means of supervised learning to predict, on the basis the measurement information associated with the parameter at the two or more time points, the one or more characteristics of the voxel of the tissue.
• Clause 19 The system of any of clauses 12-18, wherein the one or more processors are further programmed and/or configured to determine the one or more characteristics by: fitting a pharmacokinetic/pharmacodynamic (PK PD) model of the voxel of the tissue to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the PK PD model fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• PK PD pharmacokinetic/pharmacodynamic
• Clause 20 The system of any of clauses 12-19, wherein the one or more processors are further programmed and/or configured to determine the one or more characteristics by: fitting a PK PD curve of a plurality of plurality of PK/PD curves precomputed for the parameter to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the PK/PD curve fitted to the parameter at the two or more time points, the one or more characteristics of the voxel of the tissue.
• Clause 21 The system of any of clauses 12-20, wherein the one or more processors are further programmed and/or configured to determine the one or more characteristics by: approximating a curve representing the one or more characteristics of the voxel of the tissue with a set of basis functions; fitting the approximated curve to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the approximated curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• Clause 22 The system of any of clauses 12-21, wherein the one or more processors are further programmed and/or configured to determine the one or more characteristics by: fitting a curve of a plurality of curves precomputed for the parameter with a set of basis functions to the parameter of the voxel of the tissue measured at the two or more time points; determining, based on the curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• a computer program product comprising at least one non-transitory computer-readable medium including program instructions that, when executed by at least one processor, cause the at least one processor to: obtain measurement information associated with a parameter of a voxel of tissue of a patient measured at two or more time points, wherein the two or more time points occur before one or more characteristics of the voxel of the tissue are separable in an image generated based on the parameter of the voxel measured at a single time point of the two or more time points; and determine, based on the parameter of the voxel at the two or more time points, the one or more characteristics of the voxel of tissue.
• Clause 24 The computer program product of clause 23, wherein the one or more characteristics of the voxel of tissue are further determined based on information associated with at least one of the patient and a condition of the patient.
• Clause 25 The computer program product of any of clauses 23 and 24, wherein the one or more characteristics of the voxel of the tissue are determined for a time point corresponding to at least one the two or more time points.
• Clause 26 The computer program product of any of clauses 23-25, wherein the one or more characteristics of the voxel of tissue are determined for a time point subsequent to the two or more time points.
• Clause 27 The computer program product of any of clauses 23-26, wherein the instructions further cause the at least one processor to: generate, based on the one or more characteristics, one or more images including the one or more characteristics of the voxel of tissue at the time point after the two or more time points.
• Clause 29 The computer program product of any of clauses 23-28, wherein the instructions cause the at least one processor to determine the one or more characteristics by: feeding the measurement information associated with the parameter of the voxel of the tissue of the patient to a prediction model, the prediction model having been trained by means of supervised learning to predict, on the basis the measurement information associated with the parameter at the two or more time points, the one or more characteristics of the voxel of the tissue.
• Clause 30 The computer program product of any of clauses 23-29, wherein the instructions cause the at least one processor to determine the one or more characteristics by: fitting a pharmacokinetic/pharmacodynamic (PK/PD) model of the voxel of the tissue to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the PK/PD model fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• PK/PD pharmacokinetic/pharmacodynamic
• Clause 31 The computer program product of any of clauses 23-30, wherein the instructions cause the at least one processor to determine the one or more characteristics by: fitting a PK PD curve of a plurality of plurality of PK/PD curves precomputed for the parameter to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the PK/PD curve fitted to the parameter at the two or more time points, the one or more characteristics of the voxel of the tissue.
• Clause 32 The computer program product of any of clauses 23-31, wherein the instructions cause the at least one processor to determine the one or more characteristics by: approximating a curve representing the one or more characteristics of the voxel of the tissue with a set of basis functions; fitting the approximated curve to the parameter of the voxel of the tissue measured at the two or more time points; and determining, based on the approximated curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• Clause 33 The computer program product of any of clauses 23-32, wherein the instructions cause the at least one processor to determine the one or more characteristics by: fitting a curve of a plurality of curves precomputed for the parameter with a set of basis functions to the parameter of the voxel of the tissue measured at the two or more time points; determining, based on the curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• FIG. 1 is a graph of a temporal profile of concentrations of contrast agent in liver arteries (A), liver veins (V), and liver cells (P) and a summed enhancement (S) for a voxel which contains each of liver artery tissue, liver vein tissue, and liver cell tissue;
• FIG. 2 is a diagram of a system according to non-limiting embodiments or aspects
• FIG. 3 is a flowchart of non-limiting embodiments or aspects of a process for predicting, anticipating, and/or assessing tissue characteristics
• FIG. 4 shows MRI images of the liver during the dynamic and the hepatobiliary phase
• FIG. 5 shows three MRI images (1), (2) and (3) showing a liver in a first time span and an MRI image (4) showing the liver in a second time span;
• FIG. 6 is a diagram of non-limiting embodiments or aspects of an environment in which systems, devices, products, apparatus, and/or methods, described herein, can be implemented;
• FIG. 7 is a flowchart of non-limiting embodiments or aspects of a process for predicting, anticipating, and/or assessing tissue characteristics
• FIG. 8 is a non-limiting example of a pharmacokinetic model of liver tissue
• FIG. 9 shows an MRI images (3) synthesized by combining contrast information known from the HBP for liver specific contrast agents with MRI images (1), (2) of earlier phases of the liver to generate a “plain-white-liver” image;
• FIG. 10 shows non-enhanced Tlw images (1), (2), (3) synthesized from measured contrast enhanced images
• FIG. 11 shows images which show a blood vessel enhancement separate from an equilibrium uptake derived by subtracting one or more post equilibrium update images from one or more post second injection images.
• the terms “communication” and “communicate” may refer to the reception, receipt, transmission, transfer, provision, and/or the like of information (e.g., data, signals, messages, instructions, commands, and/or the like).
• one unit e.g., a device, a system, a component of a device or system, combinations thereof, and/or the like
• to be in communication with another unit means that the one unit is able to directly or indirectly receive information from and/or transmit information to the other unit. This may refer to a direct or indirect connection that is wired and/or wireless in nature.
• two units may be in communication with each other even though the information transmitted may be modified, processed, relayed, and/or routed between the first and second unit.
• a first unit may be in communication with a second unit even though the first unit passively receives information and does not actively transmit information to the second unit.
• a first unit may be in communication with a second unit if at least one intermediary unit (e.g., a third unit located between the first unit and the second unit) processes information received from the first unit and communicates the processed information to the second unit.
• a message may refer to a network packet (e.g., a data packet and/or the like) that includes data. It will be appreciated that numerous other arrangements are possible.
• computing device may refer to one or more electronic devices that are configured to directly or indirectly communicate with or over one or more networks.
• a computing device may be a mobile or portable computing device, a desktop computer, a server, and/or the like.
• computer may refer to any computing device that includes the necessary components to receive, process, and output data, and normally includes a display, a processor, a memory, an input device, and a network interface.
• a “computing system” may include one or more computing devices or computers.
• An “application” or “application program interface” refers to computer code or other data sorted on a computer-readable medium that may be executed by a processor to facilitate the interaction between software components, such as a client-side front-end and/or server-side back-end for receiving data from the client.
• An “interface” refers to a generated display, such as one or more graphical user interfaces (GUIs) with which a user may interact, either directly or indirectly (e.g., through a keyboard, mouse, touchscreen, etc.).
• GUIs graphical user interfaces
• multiple computers, e.g., servers, or other computerized devices, such as an autonomous vehicle including a vehicle computing system, directly or indirectly communicating in the network environment may constitute a “system” or a “computing system”.
• satisfying a threshold may refer to a value being greater than the threshold, more than the threshold, higher than the threshold, greater than or equal to the threshold, less than the threshold, fewer than the threshold, lower than the threshold, less than or equal to the threshold, equal to the threshold, etc.
• FIG. 1 shows schematically the temporal profile of the concentrations of contrast agent in the liver arteries (A), the liver veins (V), the liver cells (P) and a summed enhancement (S) for a voxel which contains all three types of tissue (e.g., each of liver artery tissue, liver vein tissue, and liver cell tissue), and has already been described in detail herein above.
• FIG. 2 shows schematically a system according to non- limiting embodiments or aspects.
• the system (10) comprises a receiving unit (11), a control and calculation unit (12) and an output unit (13).
• FIG. 3 is a flowchart of a method according to non-limiting embodiments or aspects.
• the method (100) comprises the steps:
• FIG. 4 shows MRI images of the liver during the dynamic and the hepatobiliary phase.
• FIGS. 4 (a), 4 (b), 4 (c), 4 (d), 4 (e) and 4 (f) the same cross section through the liver at different time points is always depicted.
• the reference signs entered in FIGS. 4 (a), 4 (b), 4 (d) and 4 (f) apply to all of FIGS. 4 (a), 4 (b), 4 (c), 4 (d), 4 (e) and 4 (f); they are each entered only once merely for the sake of clarity.
• FIG. 4 (a) shows the cross section through the liver (L) before the intravenous administration of a hepatobiliary contrast agent.
• a hepatobiliary contrast agent was administered intravenously as a bolus.
• This reaches the liver via the liver artery (A) in FIG. 4 (b).
• the liver artery is depicted with signal enhancement (arterial phase).
• a tumour (T) which is supplied with blood mainly via arteries, likewise stands out from the liver-cell tissue as a lighter (signal- enhanced) region.
• the contrast agent reaches the liver via the veins.
• the venous blood vessels (V) stand out from the liver tissue as light (signal-enhanced) regions (venous phase).
• the signal intensity in the healthy liver cells which are supplied with contrast agent mainly via the veins, continuously rises (FIG.. 4 (c) 4 (d) -> 4 (e) -> 4 (f)).
• the liver cells which are supplied with contrast agent mainly via the veins, continuously rises (FIG.. 4 (c) 4 (d) -> 4 (e) -> 4 (f)).
• the liver cells which are supplied with contrast agent mainly via the veins
• FIG.. 5 shows exemplarily and schematically how three MRI images (1), (2) and (3) showing a liver in a first time span are fed to a prediction model (PM).
• the prediction model calculates from the three MRI images (1), (2) and (3) an MRI image (4) showing the liver in a second time span.
• the MRI images (1), (2) and (3) can, for example, show the MRI images shown in Fig. 4 (b), 4 (c) and 4 (d),
• the MRI image (4) can, for example, be the MRI image shown in Fig. 4 (f).
• Imaging systems and/or image analysis systems include at least the following: identification and assessment of healthy tissue and/or different grades of pathological tissue, differentiation between different diseases and/or pathological stages, improved imaging/scan workflows, generation of cell specific and/or cell functional information, and function information on hollow or tubular organs or organ systems.
• Non-limiting embodiments or aspects of the present disclosure provide for and/or improve at least the following: the identification and assessment of healthy tissue and/or different grades of pathological tissue (e.g., diffuse pathologies, such as tissue fibrosis/cirrhosis, inflammation, fatty infiltration, functional impairment/death, and/or the like, focal pathologies, such as benign or malignant tumours, and/or the like, etc.), the differentiation between different diseases and/or pathological stages (e.g., diffuse pathologies, focal pathologies, etc.), the imaging/scan workflow (e.g., faster image generation and/or acquisition, etc.), the generation of cell specific or cell functional information (e.g., cell function, such as cell ability and speed to uptake and excrete certain drugs or metabolites, and/or the like, molecular information, such as, the amount of cell oxygenation, the expression of certain cell antigens, channels/membrane proteins, and/or the like, etc.), and/or the function information on hollow or
• Non-limiting embodiments or aspects of the present disclosure provide for voxel specific estimations of one or more of arterial circulation volume, portal venous volume, venous volume, extracellular volume, bile duct volume, normal hepatocyte volume, fatty cell volume, fibrosis volume, Kupffer cell volume, stem cell volume, other liver cell volume, and/or metastatic or other lesion or non-liver cell volumes.
• FIG. 6 is a diagram of an example environment 600 in which devices, systems, methods, and/or products described herein, may be implemented.
• environment 600 includes contrast injector 602, injector control and computation system 604, injector user interface 606 imager 608, imager control and computation system 610, imager user interface 612, image analysis and computation system 614, image analysis interface 616, image and data review interface 618, hospital information system(s) 620, and/or cloud computing and offsite resources 622.
• Systems and/or devices of environment 600 can interconnect via wired connections, wireless connections, or a combination of wired and wireless connections.
• systems and/or devices of environment 600 may interconnect (e.g., communicate information and/or data, etc.) via a cellular network (e.g., a long-term evolution (LTE) network, a third generation (3G) network, a fourth generation (4G) network, a fifth generation network (5G), a code division multiple access (CDMA) network, etc.), a public land mobile network (PLMN), a local area network (LAN), a wide area network (WAN), a metropolitan area network (MAN), a telephone network (e.g., the public switched telephone network (PSTN)), a private network, an ad hoc network, an intranet, the Internet, a fiber optic-based network, a cloud computing network, a short range wireless communication network, and/or the like, and/or any combination of these or other types of networks.
• a cellular network e.g., a long-term evolution (LTE) network, a third generation (3G) network, a fourth generation (4G) network, a fifth
• Contrast injector 602, injector control and computation system 604, and/or injector user interface 606 may comprise a contrast injection system with respective software and/or hardware to set up one or more injection protocols and deliver one or more contrast agents to a patient according to the one or more injection protocols.
• contrast injector 602, injector control and computation system 604, and/or injector user interface 606 may include a contrast injection system as described in U.S. Patent Nos. 6,643,537 and 7,937,134 and published International Application No. WO2019046299A1, the entire contents of each of which is hereby incorporated by reference.
• contrast injector 602, injector control and computation system 604, and/or injector user interface 606 may comprise the MEDRAD® Stellant FLEX CT Injection System, the MEDRAD® MRXperion MR Injection System, the MEDRAD® Mark 7 Arterion Injection System, the MEDRAD® Intego PET Infusion System, the MEDRAD® Spectris Solaris EP MR Injection System, the MEDRAD® Stellant CT Injection System With Certegra® Workstation, and/or the like.
• Imager 608, imager control and computation system 610, and/or imager user interface 612 may comprise an imaging system with respective software and/or hardware to set up imaging protocols and acquire non-contrast and contrast-enhanced scans of a patient.
• imager 608, imager control and computation system 610, and/or imager user interface 612 may include an MRI system (e.g., MRI based on Tl, T2, TWI, PD, mapping (fat, iron), a multiparametric approach, hyperpolarized MRI, MR Fingerprinting, elastography, etc.), a computed tomography (CT) system, an ultrasound system, a single-photon emission computed tomography (SPECT) system, a positron emission tomography-magnetic resonance (PET/MRI) system, a positron emission tomography- computed tomography (PET/CT) system, and/or other diagnostic imaging system.
• MRI system e.g., MRI based on Tl, T2, TWI, PD, mapping (fat, iron), a multiparametric approach, hyperpolarized MRI, MR Fingerprinting, elastography, etc.
• CT computed tomography
• SPECT single-photon emission computed tomography
• imager 608, imager control and computation system 610, and/or imager user interface 612 may include an imaging system as described in U.S. Patent Application No. 16/710,118, filed on December 11, 2019, the entire contents of which is hereby incorporated by reference.
• imager 608, imager control and computation system 610, and/or imager user interface 612 may include Siemens Healthineers’ Somatom Go CT systems, General Electric’s Signa MR systems, and/or the like.
• one or more of contrast injector 602, injector control and computation system 604, injector user interface 606, imager 608, imager control and computation system 610, imager user interface 612, image analysis and computation system 614, image analysis interface 616, image and data review interface 618, hospital information system(s) 620, and/or cloud computing and offsite resources 622 may include a computer system as described herein and/or one or more components and/or peripherals of a computer system.
• a patient may include a living organism (e.g., a mammal, a human, etc.) including multiple tissues and/or organs with different types of cells (e.g. a liver including hepatocytes, Kupffer cells, immune-cells, stem-cells, etc.), afferent and/or efferent supply/circulation systems (e.g., arteries, veins, a lymphatic or biliary system, etc.), and/or different compartments/spaces (e.g., vascular space, interstitial space, intracellular space, etc.).
• a living organism e.g., a mammal, a human, etc.
• organs e.g. a liver including hepatocytes, Kupffer cells, immune-cells, stem-cells, etc.
• afferent and/or efferent supply/circulation systems e.g., arteries, veins, a lymphatic or biliary system, etc.
• a contrast agent delivered to a patient by a contrast injection system may be selected or configured according to a type of the imaging system used to scan the patient.
• a contrast agent may include gadolinium-based contrast agents (GBCA) (e.g., for use in MRI, etc.), iodine based contrast agents (e.g., for use in CT, etc.) an ultrasound contrast media (e.g., microbubbles, etc.), and/or other more uncommon contrast agents, such as iron-based agents (e.g., small, or ultra-small superparamagnetic iron oxide, manganese -based, C02, or other agents), blood pool agents (e.g., having an intravascular long blood half-life), agents with kidney dominant or hepatobiliary dominant excretion, agents with intracellular uptake, and organ-specific or cell- specific uptake, agents with organ- or cell specific binding (e.g., without intracellular uptake), agents with long “retention ” (e.g.
• a contrast agent may be radioactive.
• a contrast agent may be cell marker specific, meaning that it bonds or interacts with certain cell surface or cell interior markers.
• the contrast agent involved may be a native contrast, for example oxygen levels in haemoglobin.
• a contrast agent maybe a negative contrast, for example which reduces the haematocrit and, thus, the red blood cell signal in the blood or microbubbles, which replaces the blood with a gas. In normal MRI, the gas gives no signal and in CT the gas produces increased transmission and thus reduced Hounsfield units.
• a contrast injection system may deliver a single agent (e.g., a single contrast agent delivered by itself, etc.) or multiple contrast agents in combination at the same time (e.g., multiple parallel injections, an injection of two fluids mixed together, or one after the other (e.g., multiple consecutive injections)).
• An imaging system can perform a single image acquisition or scan at one or more time points (phases), multiple acquisitions at one or more time points (e.g, using MR-mapping techniques, etc.), and/or an acquisition across continuous imaging periods.
• a contrast injection may be delivered to one or more different locations or compartments, such as a venous vascular compartment, an arterial vascular compartment, a lymphatic vascular compartment, and/or the like.
• FIG. 7 is a flowchart of non-limiting embodiments or aspects of a process 700 for predicting, anticipating, and/or assessing tissue characteristics.
• one or more of the steps of process 700 may be performed (e.g., completely, partially, etc.) by image analysis and computation system 614 (e.g., one or more devices of image analysis and computation system 614).
• one or more of the steps of process 700 may be performed (e.g., completely, partially, etc.) by another device or a group of devices separate from or including image analysis and computation system 614, such as imager control and computation system 610 (e.g., one or more devices of imager control and computation system 610), hospital information system(s) 620 (e.g., one or more devices of hospital information system(s)), cloud computing and offsite resources system 622 (e.g., one or more devices of cloud computing and offsite resources system 622), and/or the like.
• imager control and computation system 610 e.g., one or more devices of imager control and computation system 610
• hospital information system(s) 620 e.g., one or more devices of hospital information system(s)
• cloud computing and offsite resources system 622 e.g., one or more devices of cloud computing and offsite resources system 622
• process 700 includes delivering contrast agent to a patient.
• a contrast injection system may deliver (e.g., inject, etc.) contrast agent to a patient.
• contrast injector 602, injector control and computation system 604, and/or injector user interface 606 may set up one or more injection protocols and deliver one or more contrast agents to a patient according to the one or more injection protocols.
• contrast agent may be delivered to a patient in a compact, short and relatively quick bolus to allow individual phases (e.g., an arterial phase, a portal-venous phase, a venous phase, etc.) to be distinguished.
• individual phases e.g., an arterial phase, a portal-venous phase, a venous phase, etc.
• contrast concentration may be relatively homogenous during a short period of “steady state” before contrast distributes through the body to allow for a short phase of steady state imaging.
• contrast agent may be delivered to a patient to slow down or stretch the injection time of the contrast agent as described in U.S. Patent No. 9,436,989, the entire contents of which is hereby incorporated by reference.
• contrast agent may be delivered to a patient to achieve a desired MR contrast concentration in blood and/or in tissue such that an MR fingerprint can include one or more contrast related parameters as described in U.S. Patent Application No. 16/462,410, filed on November 21, 2017, the entire contents of which is hereby incorporated by reference.
• an injection speed/delivery of a contrast agent may be performed as a single fast bolus (e.g., to distinguish phases), as a single bolus to enable imaging in real time from time X to time Y, as two discrete image periods (e.g., 0.5 to 2 min and then 10 or 20 min, etc.), as a single slow bolus (e.g., with normal phases not visibly distinguishable , etc.), or as a dual bolus (e.g., in a sequence including delivery of a first bolus, waiting, imaging, delivery of a second bolus, and imaging, etc.).
• a single fast bolus e.g., to distinguish phases
• two discrete image periods e.g., 0.5 to 2 min and then 10 or 20 min, etc.
• a single slow bolus e.g., with normal phases not visibly distinguishable , etc.
• dual bolus e.g., in a sequence including delivery of a first bolus, waiting
• process 700 includes obtaining measurement information associated with tissue of a patient.
• an imaging system may set up one or more imaging protocols and acquire non-contrast and/or contrast-enhanced scans of tissue of the patient to obtain measurement information associated with the tissue of the patient (e.g., one or more images or scan of the tissue of the patient, etc.) according to the one or more imaging protocols.
• imager 608, imager control and computation system 610, and/or imager user interface 612 (and/or image analysis and computation system 614) may obtain measurement information associated with a parameter of a voxel of tissue of the patient measured at two or more time points (e.g., values of the parameter of the voxel of the tissue at the two or more time points, images or scans of the tissue including or showing the parameter at the two or more time points, etc.).
• the two or more time points occur before one or more characteristics of the voxel of tissue are separable (e.g., separable from one or more other characteristics and/or noise in the measurement data and/or an image created from the measurement data, etc.) and/or discernible (e.g., discernible by a human eye, etc.) in an image generated based on the parameter of the voxel at a single time point of the two or more time points.
• separable e.g., separable from one or more other characteristics and/or noise in the measurement data and/or an image created from the measurement data, etc.
• discernible e.g., discernible by a human eye, etc.
• measurement information may be obtained (e.g., scanned, imaged, etc.) at different (e.g., discrete) times or continuously before, during, and/or after contrast injection resulting in one or more of the following parameter/image acquisition phases: a native phase (e.g., before contrast), an arterial phase, a portal venous phase, a venous phase, an equilibrium phase, in a case of hepatobiliary uptake and excretion: a hepatobiliary phase (HBP), and/or as a continuous image acquisition over one or more phases.
• a native phase e.g., before contrast
• an arterial phase e.g., a portal venous phase
• a venous phase e.g., an equilibrium phase
• HBP hepatobiliary phase
• HBP hepatobiliary phase
• image acquisition or scanning to obtain measurement data may be started at a time point (e.g., an optimal time point, etc.) determined based on a circulation time of a patient as described in EP Patent Application No. 20161359.3, the entire contents of which hereby incorporated by reference.
• a time point e.g., an optimal time point, etc.
• measurement information including one or more parameters of a voxel of tissue may be obtained using at least one of the following techniques: an MRI acquisition technique (e.g., MRI based on Tl, T2, TWI, PD, mapping (fat, iron), a multiparametric approach, hyperpolarized MRI, MR Fingerprinting, elastography, etc.), a CT acquisition technique, an ultrasound technique, a SPECT technique, a PET/MRI technique, a PET/CT technique, another diagnostic imaging technique, or any combination thereof.
• an MRI acquisition technique e.g., MRI based on Tl, T2, TWI, PD, mapping (fat, iron), a multiparametric approach, hyperpolarized MRI, MR Fingerprinting, elastography, etc.
• CT acquisition technique e.g., an ultrasound technique, a SPECT technique, a PET/MRI technique, a PET/CT technique, another diagnostic imaging technique, or any combination thereof.
• a parameter of a voxel of tissue measured by an imaging system may include at least one of the following: Tl weighted (Tlw), T2 weighted (T2w), proton density weighted (PDw), diffusion weighted (DWI), x-ray absorption amount, a shortening amount of Tl and/or T2 relaxation times, a change in x-ray absorption amount, a tracer uptake amount/a metabolism and registration of emissions, one or more pharmacokinetic model parameters, or any combination thereof.
• an image acquired by an imaging system may include or show the parameter of the voxel of the tissue at the time the parameter is measured by the imaging system.
• process 700 includes determining one or more characteristics associated with tissue of a patient.
• image analysis and computation system 614 may determine, based on the parameter of the voxel at the two or more time points, the one or more characteristics.
• image analysis and computation system 614 may generate, based on the measurement information including the one or more parameters of the voxel at the two or more time points (and/or images including or showing the parameter of the voxel at the two or more time points), one or more images including or showing the one or more characteristics of the voxel of the tissue of the patient.
• image analysis and computation system 614 may synthesize, enhance, combine, and/or replace/eliminate one or more images acquired and/or not acquired by the imaging system that acquired or measured the measurement information including the parameter of the voxel at the two or more time points.
• a single characteristic may be displayed as a gray scale image.
• two or more characteristics may be displayed as a color overlay on a gray scale image .
• the one or more characteristics (and/or the one or more images including or showing the one or more characteristics) may be determined for a time point and/or a time period corresponding to (e.g., at the same time as, etc.) one or more of the two or more time points.
• the one or more characteristics may be determined for a time point and/or a time period after the two or more time points (e.g., subsequent to the two or more time points, etc.).
• a characteristic associated with tissue of a patient may include at least one of the following: a concentration of contrast agent in arteries of a voxel (e.g., in liver arteries (A), etc.), a concentration of contrast agent in veins of a voxel (e.g., in liver veins (V), etc.), a concentration of contrast agent in cells of a voxel (e.g., in liver cells (P), etc.), a summed enhancement of the concentration of contrast agent in the arteries, veins, and cells of a voxel (e.g., a summed enhancement ofthe concentration of contrast agent in the liver arteries (A), the liver veins (V), the liver cells (P) of a voxel of liver tissue, etc.), one or more of the pharmacokinetic parameters associated with contrast movement through the tissue spaces of a voxel, or any combination thereof.
• a concentration of contrast agent in arteries of a voxel e.
• example but non-limiting data analysis steps may include data analysis 711 which, for example turns the acquired data or images into human readable images, data analysis 712 which, for example uses two or more images to create a previously non-existing image in human readable form, data analysis 713 which, for example may inform the reader or recommend or make a diagnosis for confirmation by the medical professional involved.
• data analysis 711 which, for example turns the acquired data or images into human readable images
• data analysis 712 which, for example uses two or more images to create a previously non-existing image in human readable form
• data analysis 713 which, for example may inform the reader or recommend or make a diagnosis for confirmation by the medical professional involved.
• Computer aided diagnosis algorithms are an example of this data analysis.
• image analysis and computation system 614 may determine, based on the measurement information including the parameter of the voxel at the two or more time points, the one or more characteristics (and/or the one or more images including or showing the one or more characteristics, and/or diagnosis information associated therewith) using at least one of the following techniques: a window & level technique, a gamma correction technique, a filtered back projection technique, an iterative reconstructions technique, a model fitting technique, a dictionary mode of curve fitting technique (e.g., MR-fingerprinting, etc.), a spatial, temporal filtering and enhancement technique, a feature extraction technique using CAD or AI, a fractal analysis technique, a motion correction technique, a flexible registration technique, a parameter quantification technique, 2D AI or machine learning based analysis of a single image, a 2D AI or machine learning based analysis technique of time sequence for a voxel, a 3D AI or machine learning based analysis technique of a time sequence of images technique, an AI or
• image analysis and computation system 614 may determine that the measurement information associated with the parameter of the voxel of the tissue of the patient includes a threshold amount of measurement information associated with determining the one or more characteristics of the voxel of the tissue (e.g., a sufficient amount of information and/or data to determine the one or more characteristics and/or the one or more images including the one or more characteristics, etc.) and, in response to determining that the measurement information includes the threshold amount of measurement information, control an imaging system (e.g., imager 608, etc.) to automatically stop acquisition of the measurement information (e.g., to stop scanning or imaging the patient, etc.).
• a threshold amount of measurement information associated with determining the one or more characteristics of the voxel of the tissue (e.g., a sufficient amount of information and/or data to determine the one or more characteristics and/or the one or more images including the one or more characteristics, etc.) and, in response to determining that the measurement information includes the threshold amount of measurement information, control an imaging system (e.
• the threshold amount of measurement information associated with determining the one or more characteristics of the voxel of the tissue may include a threshold amount of information associated with providing one or more selected or predetermined diagnoses for the patient, optionally with a predetermined level of parameter differentiation, confidence of prediction, or margin of error.
• image analysis and computation system 614 may synthesize one or more images (e.g. generate or create one or more composite or enhanced images, one or more non-enhanced/contrast-enhanced/tracer images, one or more Tlw/T2w/PDw images (and/or variants of those, e.g., with/without fat-sat., with inversion pulses, etc.), one or more images of the arterial/portal venous/venous/equilibrium/HB phases, one or more images of MRI continuous acquisitions, one or more non-enhanced/contrast- enhanced/tracer x-ray absorption images, one or more arterial/portal venous/venous/equilibrium/or continuous acquisition x-ray absorption images, etc.) of the voxel of the tissue of the patient based on the measurement information including the parameter of the voxel at the two or more time points (and/or the one or more images
• image analysis and computation system 614 may synthesize one or more images in the HBP from the measurement information including the parameter of the voxel at the two or more time points measured in one or more phases that occur before the HBP.
• image analysis and computation system 614 may synthesize one or more images by combining (e.g., adding, subtracting, multiplying, etc.) contrast information known from the HBP for liver specific contrast agents with one or more images of earlier phases of the liver (e.g. one or more images measured or acquired in the arterial, portal-venous, and/or venous phase, etc.) to generate a “plain-white- liver” as shown in FIG. 9 and described in further detail in EP Patent Application No.
• image analysis and computation system 614 may synthesize non-enhanced Tlw images from one or more measured contrast enhanced images (e.g. in the liver, etc.) as shown in FIG. 10 and described in further detail in EP Patent Application No. 19201919.8, filed on October 8, 2019, the entire contents of which is hereby incorporated by reference.
• image analysis and computation system 614 may enhance certain image contrasts (e.g., contrast of the arterial phase enhancement in a contrast- enhanced Tlw MR-image to enable high-contrast, high-accuracy imaging of tissues and tumours with reduced amounts of contrast agent, etc. as described in EP Patent Application No. 19201937.0, filed on October 8, 209, and U.S. Provisional Patent Application No. 62/943,980, filed on December 5, 2019, the entire contents of each of which is hereby incorporated by reference.
• image analysis and computation system 614 may synthesize contrast-enhanced Tlw images of the equilibrium phase (e.g., virtual blood-pool contrast images, etc.) as described in EP Patent Application No.
• image analysis and computation system 614 may synthesize images without gadoxetic acid-induced contrast changes within hepatocytes during the transitional phase or later phases from conventional gadoxetic-acid enhanced images.
• image analysis and computation system 614 may synthesize “pseudo images” based on a set of conventionally acquired mapping sequences that contain information on the full relaxation curve of a tissue over a pharmacokinetic timeframe while a substance (e.g. contrast agent) is passing though the tissue.
• a double injection protocol of contrast may be used, as shown in FIG. 11 and described in further detail in EP Patent Application No. 19201919.8, filed on October 8, 2019, EP Patent Application No. 19202711.8, filed on October 11, 2019, and EP Patent Application No. 20173089.2, filed on May 6, 2020, the entire contents of each of which is hereby incorporated by reference .
• a first inj ection of the double inj ection may be performed while the patient is not in the scanner.
• the first injection may, for example, be gadoxetic acid if the study is to be an MRI study. The patient remains out of the scanner while the contrast equilibrates in the body and is taken up by the target tissues.
• image analysis and computation system 614 may subtract one or more post equilibrium update images from the one or more post second injection images to derive images which show the blood vessel enhancement separate from the equilibrium uptake at the corresponding points in time.
• the second contrast injection may be the same type of contrast as the first, or because the uptake has already occurred and has been imaged, it may be a different type of contrast, for example gadobutrol which has different and, in some ways, advantageous properties to gadoxetic acid.
• two different contrasts may be mixed or injected simultaneously.
• a contrast agent with properties that make it preferable as a vascular contrast may be mixed with a contrast agent that is not as useful as a vascular phase contrast but has properties as a cell or tissue specific marker or contrast.
• process 700 includes analysing one or more characteristics associated with tissue of a patient.
• a radiologist and/or other trained professional may read the one or more images including the one or more characteristics associated with the tissue of the patient to derive diagnosis information from the one or more images.
• image analysis and computation system 614 may analyse the one or more characteristics associated with the voxel of the tissue of the patient and/or the one or more images the one or more characteristics associated with the tissue of the patient to derive diagnosis information from the one or more images.
• image analysis and computation system 614 may feed the one more characteristics (and/or the one or more images including or showing the one or more characteristics), to a classification model, the classification model having been trained by means of supervised learning to classify, on the basis of the one more characteristics (and/or the one or more images including or showing the one or more characteristics, the tissue as associated with one or more diagnoses.
• image analysis and computation system 614 may determine one or more diagnoses for the tissue using one or more of the techniques described herein above with respect to step 706 used to determine the one or more characteristics of the tissue.
• diagnosis information may include an identification of a state (e.g., healthy tissue, non-healthy tissue, a type of non-healthy tissue, a type of illness associated with the tissue, etc.) of the voxel of the tissue of the patient, one or more reasons for the identification of the state of the voxel of the tissue of the patient, or any combination thereof.
• a state e.g., healthy tissue, non-healthy tissue, a type of non-healthy tissue, a type of illness associated with the tissue, etc.
• process 700 includes providing a diagnosis associated with tissue of a patient.
• a radiologist and/or other trained professional may provide the diagnosis information associated with the tissue of the patient.
• image analysis and computation system 614 may provide the diagnosis information associated with the tissue of the patient.
• additional information about the patient and/or a condition of the patient may be input and used at one or more of stages 702-710 to focus or affect selection among options at each stage and/or the determination of the information and/or data determined and/or generated at each stage.
• the additional information about the patient and/or the condition of the patient may be input to a process, an algorithm, a machine learning model or neural network, a model fitting analysis, and/or the like used to determine the injection protocol, the imaging protocol, the measurement information, the one or more characteristics (and/or the one or more images including or showing the one or more characteristics), the diagnosis information, and/or the diagnosis.
• additional information associated with the patient and/or a condition of the patient, and/or desired conditions for the study may include at least one of the following: a height of the patient, a weight of the patient, an age of the patient, a gender of the patient, a heart rate of the patient, a cardiac output of the patient, a clinical symptom of the patient, a bilirubin level of the patient, a desired rate, rise and/or plateau level of the concentration of the contrast delivered to the patient, or any combination thereof. Additional examples of patient specific data may be found in U.S. Patent Nos. 5,840,026 and 9,616,166, the contents of each of which is hereby incorporated by reference.
• the data analysis steps 711, 712, 713 and associated computer hardware and/or software, for example image analysis and computation system 614, may also access and use the additional data 720 about the patient which, for example, may be obtained from the hospital information system 620 and/or other cloud computing data stores 622.
• FIG. 8 shows a simplified schematic of a voxel 800 (e.g., a volume element, etc.) of an organ of a patient being imaged.
• a voxel 800 e.g., a volume element, etc.
• This schematic is representative of the liver, but applies in general to other organs with appropriate adaptations or simplifications.
• the liver is a relatively complicated organ as is well known in medicine and physiology.
• Each of the example elements may occupy some fractional volume of the voxel.
• the liver receives a dual blood supply from the hepatic portal vein 304 and hepatic arteries 302.
• the hepatic portal vein 304 delivers around 75% of the liver's blood supply and carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs.
• the hepatic veins 306 carry the blood back to the heart.
• the voxel may contain other cells 313 which effectively do not take up the contrast.
• extracellular space 301 which represents the fluid and connective molecules that hold all these other components in place.
• extracellular space 301 which represents the fluid and connective molecules that hold all these other components in place.
• voxels which are fully within one type of components, for example an artery, a vein, or a bile duct.
• Other voxels will have other fractions of the voxel elements.
• PK PD modelling (pharmacokinetic/pharmacodynamic modelling) is a technique that combines the two classical pharmacologic disciplines of pharmacokinetics and pharmacodynamics. It integrates a pharmacokinetic and a pharmacodynamic model component into one set of mathematical expressions that allows the description of the time course of effect intensity in response to administration of a drug dose.
• K1A and K2A are the transport constants respective out of and into the hepatic arteries 302 and associated capillaries.
• K1V and K2V are the constants for the portal vein 304.
• K3 and K4 are the constants for the cells which take up contrast and
• K5 and K6 are the constants for the transport into and back from the bile ducts.
• a PK/PD model also determines as parameters one or more of the fractional volumes of each voxel that is occupied by the various compartments: arterial blood, portal venous blood, venous blood, extracellular fluid, extracellular matrix, and cells of various types, for example hepatocytes and non-hepatocytes.
• the images acquired are of high enough quality that a radiologist can look at them comfortably and reliably read them to reach his/her diagnosis. This commonly means that tens of seconds or even minutes of scan time is required to create a single image.
• Techniques are being developed to speed up the creation of viewing acceptable MRI images. These techniques include, for example, parallel imaging, compressed sensing, sparse imaging, and many other techniques. Images created using these techniques may be used in various non-limiting embodiments or aspects of the present disclosure, for example, to determine the one or more characteristics of the voxel of the tissue of the patient as described herein.
• step 704 faster but noisier images may be created using an acquisition time of only a few seconds or tens of seconds.
• the data captured for each voxel e.g., the measurement information, a parameter of the voxel of tissue measured at two or more time points, etc.
• the data captured for each voxel can better measure or approximate the shape of curve S of FIG. 1, albeit with some noise in the measurement that may still be objectionable or confusing to a human visual observer.
• the time sequence of noisier images (e.g., the measurement information, a parameter of the voxel of tissue measured at two or more time points, etc.) can be fed to a prediction model (e.g., an artificial neural network, a prediction model as described herein, etc.), the prediction model having been trained by means of supervised learning to predict, on the basis of the measurement information including a parameter of the voxel of tissue measured at two or more time points, the one or more characteristics (and/or the one or more images including or showing the one or more characteristics) at a time point and/or a time period corresponding to a time point of the two or more time points and/or at time point and/or a time period after the two or more time points (e.g., subsequent to the two or more time points, etc.).
• a prediction model e.g., an artificial neural network, a prediction model as described herein, etc.
• the time sequence of noisier images may be used to fit various model parameters to the data (e.g., to the parameter of the voxel of the tissue measured at the two or more time points, etc.).
• the PK/PD model of FIG. 8 may be fit to the parameter of the voxel of the tissue measured at the two or more time points (e.g., to the curve the measured for each voxel, etc.).
• image analysis and computation system 614 may fit a PK/PD model of the voxel of the tissue to the parameter of the voxel of the tissue measured at the two or more time points, and determine, based on the PK/PD model fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• the parameter(s) or necessary input functions may be measured using voxels that are fully hepatic artery and portal vein.
• curve fitting methods known in the literature. Least squares curve fitting is a simple, but not necessarily the most efficient or effective method.
• One that may be advantageous to use in non-limiting embodiments or aspects of the present disclosure employs a comparison, matching, or fingerprinting to find the best fit in a set of ideal PK PD curves precomputed for each of a discrete set of parameters and placed in a database or dictionary, as was discussed by Dr. Nicole Seiberlich during the RSNA 2018, course RC629C for a simple extracellular contrast (meaning K3 - K6 are zero) as a way to measure liver perfusion.
• the image at a corresponding time and any future point in time may be estimated by carrying the PK/PD equations forward for each voxel and translating the concentration into a signal intensity, and PK PD measures over time, such as drug uptake, distribution, and excretion, which allow certain conclusions on cellular function of, for example, kidneys, the liver, and the blood-brain-barrier, can be determined from the relative or absolute contrast induced tissue enhancement over time.
• image analysis and computation system 614 may fit a PK PD curve of a plurality of plurality of PK PD curves precomputed for the parameter to the parameter of the voxel of the tissue measured at the two or more time points, and determine, based on the PK PD curve fitted to the parameter at the two or more time points, the one or more characteristics of the voxel of the tissue.
• an input function is commonly used.
• an input function can be measured in an image, for example in an image of the aorta adjacent to the liver.
• the longer bolus causes the input function to be less variably based on the patient and more determined by the injection duration. This may be preferable in some types of analysis, modelling or curve fitting described herein by limiting the range of parameters that can be expected to occur in the model.
• One drawback to the longer bolus may be that the normal arterial, portal venous, or other phase images are not available because of the overlap in time. If it is desirable to present the “standard” images to the radiologist, image analysis and computation system 614 may analyse the one or more characteristics of the model for each voxel and the “standard images” may be constructed from the models parameters for that voxel.
• This longer bolus approach may be especially beneficial in PET imaging to avoid detector saturation or pulse pile up and dead space correction effects. It may also be beneficial to CT by enabling fewer scans to be taken because the contrast levels are changing at a slower rate and the timing can be better predicted and not as variable depending upon the patient’s physiology. Where appropriate to a diagnostic question being asked and the characteristics being assessed, simplified PK/PD models such as Patlak analysis and/or other such models be used.
• curve S is approximated by, or curve S is decomposed into, a set of selected basis functions (e.g., a set of polynomial function, a set of Laplace functions, a set of Fourier functions, etc.).
• a basis function is an element of a particular basis for a function space. Every continuous function in the function space can be represented as a linear combination of basis functions, just as every vector in a vector space can be represented as a linear combination of basis vectors.
• image analysis and computation system 614 may approximate a curve representing one or more characteristics of a voxel of tissue with a set of basis functions, fit the approximated curve to one or more parameters of the voxel of the tissue measured at two or more time points, and determine, based on the approximated curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, the one or more characteristics of the voxel of the tissue.
• a curve representing one or more characteristics of a voxel of tissue with a set of basis functions
• the first pass contrast enhancement over time curve may be modelled or approximated as a gamma variate curve according to the following Equation (1):
• non-limiting embodiments or aspects are not limited to using gamma variate curves for the modeling, and any other set of basis functions (e.g., a set of polynomial function, a set of Laplace functions, a set of Fourier functions, etc.) may be used for the modeling, and any computationally efficient curve fitting program may be used determine the best fit parameters to a measured curve S.
• image analysis and computation system 614 may fit a curve of a plurality of curves precomputed for one or more parameters with a set of basis functions to one or more parameters of a voxel of tissue measured at two or more time points, and determine, based on the curve fitted to the parameter of the voxel of the tissue measured at the two or more time points, one or more characteristics of the voxel of the tissue.
• a longer contrast bolus or injection may cause a curve S to have a slower rise and fall, which may affect or constrain the basis function parameters that are expected in the model, and so may simplify, speed up, or increase the accuracy of the curve fitting activity and/or the resulting model.
• images may be created or information derived that could never be independently measured in the physical situation.
• the “white liver” of FIG. 9 is anon-limiting example of this.
• Another non- limiting example or aspect is an image or sequence of images created to show the contrast flowing through the liver over time as if contrast only came into the liver through the portal vein and none came in through the portal artery, or vice-versa.
• images may be created that would have occurred with the use of a very fast or short bolus, even though a longer bolus would have been actually used in the overall imaging protocol.
• image analysis and computation system 614 may analyse the one or more characteristics associated with the voxel of the tissue of the patient and/or the one or more images the one or more characteristics associated with the tissue of the patient to calculate absolute values for the wash-out of a lesion over time, compared to the arterial phase enhancement (e.g., liver).
• the arterial phase enhancement e.g., liver
• the washout of a lesion is usually assessed visually, by comparing the enhancement of the surrounding tissue with that of the lesion during contrast phases that follow the arterial phase.
• an examination region includes the liver or a portion of the liver of a mammal (preferably a human).
• an examination region may include the lungs or a portion thereof.
• the lungs receive circulation of deoxygenated blood from the right heart and also oxygenated blood from the left heart.
• the lungs receive gas through the airways.
• the lungs may receive contrast either intravenously or gaseous contrast through the airways.
• non-limiting embodiments or aspects of the present disclosure may apply to inhaled contrast, as well as IV injected contrast.
• most tissue acts as a lymphatic system (e.g., the glymphatic system in the brain) for circulation of fluids through the extracellular space of tissue.
• Non-limiting embodiments or aspects of the present disclosure may include contrast flows, or lack thereof, through this lymphatic or glymphatic system.
• tissue characteristics and voxel parameters have been listed for understanding and disclosure. It should be recognized that these are exemplary and not limiting or an exhaustive list. Other characteristics and/or parameters known in the medical art may be used. In addition, characteristics and/or parameters in research or yet to be discovered my also benefit from the application of non-limiting embodiments or aspects of the present disclosure in the processing, imaging, and/or analysing of the data from an imaging study and/or a sequence of studies.

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